Prospective Evaluation of Percutaneous Endoscopic Gastrostomy Related Peritonitis in the Surgical Intensive Care Unit (sicu) — A Preliminary Analysis

Introduction: The purpose of this study was to prospectively examine the impact of technical factors during percutaneous endoscopic gastrostomy (PEG) tube placement on the development of subsequent peritonitis. Determination of whether BMI or nutritional status were independent risk factors for the development of this complication were secondary endpoints.
Methods: All patients undergoing PEG tube placement in the SICU at William Beaumont Hospital from August 2006 to January 2008 were included. Patient demographics including age, BMI, and albumin were prospectively collected and evaluated for the development of peritonitis. Technical factors including abdominal wall trans-illumination and indentation of the anterior gastric wall were graded by the surgical endoscopist as Excellent/Good/Fair/Poor. These grades were then converted into continuous numerical scores of 1/2/3/4. Overall technical difficulty of the procedure was quantified as None/Some/A lot (score 1/2/3). These 3 individual scores and the cumulative scores (all 3 combined) were recorded. Data was analyzed with SAS (version 9.1.3).
Results: Over 18 months, 110 patients had PEG tubes placed in SICU by 3 surgical intensivists. The patients’ mean age was 68. 61 patients (55%) were male. Four patients (3.6%) had peritonitis from leaking of gastric contents around the PEG tube requiring a laparotomy. There was no difference between the BMI (31 +/- 3.2 vs. 28.1 +/- 7.6, p = 0.15) and serum albumin (2.5 +/- 0.5 vs. 2.7 +/- 0.5, p = 0.45) in the peritonitis group and the non-peritonitis group. Cumulative technical score was 6.3 in the peritonitis group and 4.7 in the non-peritonitis group (Wilcoxon’s Rank test, p-value 0.043). Of the individual scores, trans-illumination was poor (score of 4) in 2 patients (50%) in the peritonitis group and 8 (7.3%) patients in the non-peritonitis group (Fisher’s exact test, p-value 0.041). There was no difference in the indentation of gastric wall and overall technical difficulty score between the 2 groups (p-values 0.20 & 0.58 respectively).
Conclusion: Our prospective observations suggest a relation between certain technical factors and development of peritonitis. Trans-illumination seems to be the most important aspect of PEG tube placement and resultant peritonitis could be secondary to suboptimal approximation of anterior gastric wall to the abdominal wall. Non-significance of the BMI and serum albumin in the development of peritonitis was likely secondary to a smaller study size. A larger study with adequate power is required to validate these preliminary findings.

Session: Podium Presentation

Program Number: S067

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